AB445,24,1212
(b) For purposes of this subsection, all of the following apply:

AB445,24,14131. All persons treated as a single employer under section 414 (b), (c), (m), or (o) 14of the Internal Revenue Code shall be treated as a single employer.

AB445,24,1615
2. An employer and any predecessor employer shall be treated as a single 16employer.

AB445,24,1817
3. All employees shall be counted, including part-time employees and 18employees who are not eligible for coverage through the employer.

AB445,24,2219
4. If an employer was not in existence during the entire preceding calendar 20year, the determination of whether that employer is a small employer shall be based 21on the average number of employees that it is reasonably expected that employer will 22employ on business days in the current calendar year.

AB445,25,223
5. An employer that makes enrollment in qualified health plans available to 24its employees through the SHOP Exchange and that would cease to be a small 25employer by reason of an increase in the number of its employees shall continue to 1be treated as a small employer for purposes of this chapter as long as it continuously 2makes enrollment through the SHOP Exchange available to its employees.

AB445,25,85636.25Generalmatters.(1) The authority shall establish and operate a 6Wisconsin Health Benefit Exchange and shall make qualified health plans, with 7effective dates on or before January 1, 2018, available to qualified individuals and 8qualified employers.

AB445,25,109(2) (a) The authority may not make available any health benefit plan that is 10not a qualified health plan.

AB445,25,1511
(b) The authority shall allow a health carrier to offer a plan that provides 12limited scope dental benefits meeting the requirements of section 9832 (c) (2) (A) of 13the Internal Revenue Code through the exchange under sub. (1), either separately 14or in conjunction with a qualified health plan, if the plan provides pediatric dental 15benefits meeting the requirements of section 1302 (b) (1) (J) of the federal act.

AB445,25,2216(3) Neither the authority nor a health carrier offering health benefit plans 17through the exchange under sub. (1) may charge an individual a fee or penalty for 18termination of coverage if the individual enrolls in another type of minimum 19essential coverage because the individual has become newly eligible for that 20coverage or because the individual's employer-sponsored coverage has become 21affordable under the standards of section 36B (c) (2) (C) of the Internal Revenue 22Code.

AB445,26,223(4) The authority may enter into information-sharing agreements with federal 24and state agencies and entities operating exchanges in other states to carry out its 25responsibilities under this chapter, provided that such agreements include adequate 1protections with respect to the confidentiality of the information to be shared and 2comply with all state and federal laws and rules and regulations.

AB445,26,53636.30Exchange duties and powers.(1) In addition to all other duties 4imposed under this chapter, the authority shall do all of the following relating to the 5exchange under s. 636.25 (1):

AB445,26,96
(a) Implement procedures for the certification, recertification, and 7decertification, consistent with guidelines developed by the secretary under section 81311 (c) of the federal act and s. 636.42, of health benefit plans as qualified health 9plans.

AB445,26,1110
(b) Provide for the operation of a toll-free telephone hotline to respond to 11requests for assistance.

AB445,26,1614
(d) Maintain an Internet site through which enrollees and prospective 15enrollees of qualified health plans may obtain standardized comparative 16information on such plans.

AB445,26,2117
(e) Assign a rating to each qualified health plan offered through the exchange 18in accordance with the criteria developed by the secretary under section 1311 (c) (3) 19of the federal act, and determine each qualified health plan's level of coverage in 20accordance with regulations issued by the secretary under section 1302 (d) (2) (A) of 21the federal act.

AB445,26,2422
(f) Use a standardized format for presenting health benefit options in the 23exchange, including the use of the uniform outline of coverage established under 42 24USC 300gg-15.

AB445,27,97
(j) Establish, in consultation with the commissioner, the method for 8determining the amount of the surcharge under s. 636.45 (1) and establish the 9procedure for imposing and collecting the surcharge.

AB445,27,1110
(k) Establish a plan for publicizing the exchange and the eligibility 11requirements and enrollment procedures.

AB445,27,1312
(L) Establish and operate a service center to provide information to small 13employers, individuals, enrollees, and insurance intermediaries about the exchange.

AB445,27,1514
(m) Establish a mechanism for regular communication and cooperation with 15insurance intermediaries.

AB445,27,1716
(n) Establish an independent and binding appeals process for resolving 17disputes over eligibility and other determinations made by the authority.

AB445,27,2218
(o) In accordance with section 1413 of the federal act, inform individuals of 19eligibility requirements for Medical Assistance under subch. IV of ch. 49 or any other 20applicable state or local public program and if, through screening of the application 21by the authority, the authority determines that any individual is eligible for any such 22program, assist that individual to enroll in that program.

AB445,28,223
(p) Establish and make available by electronic means a calculator to determine 24the actual cost of coverage after application of any premium tax credit under section 136B of the Internal Revenue Code and any cost-sharing reduction under section 21402 of the federal act.

AB445,28,63
(q) Establish a SHOP Exchange through which qualified employers may access 4health care coverage for their employees and that shall enable any qualified 5employer to specify the level of coverage at which its employees may enroll in any 6qualified health plan offered through the SHOP Exchange.

AB445,28,97
(r) Perform duties required of the authority by the secretary or the federal 8secretary of the treasury related to determining eligibility for premium tax credits, 9reduced cost sharing, or individual responsibility requirement exemptions.

AB445,28,1310
(s) Select entities, which may include insurance intermediaries, that are 11qualified to serve as navigators in accordance with section 1311 (i) of the federal act 12and standards developed by the secretary, and award grants to enable navigators to 13do all of the following:

AB445,28,1514
1. Conduct public education activities to raise awareness of the availability of 15qualified health plans.

AB445,28,2521
4. Provide referrals to any applicable office of health insurance consumer 22assistance or health insurance ombudsman established under 42 USC 300gg-93, or 23to any other appropriate state agency or agencies, for any enrollee with a grievance, 24complaint, or question regarding the enrollee's health benefit plan, coverage, or 25determination under that plan or coverage.

AB445,29,215. Provide information in a manner that is culturally and linguistically 2appropriate to the needs of the population being served by the exchange.

AB445,29,53
(t) Assist in the coordination of any necessary administrative operations 4between the department of corrections and the department of health services to 5ensure all of the following:

AB445,29,86
1. That an individual, upon placement in a correctional facility, is disenrolled 7for the duration of his or her incarceration from any health care coverage in which 8he or she is enrolled.

AB445,29,139
2. That an individual who is incarcerated in a correctional facility, but 10scheduled to be released from incarceration in the near future, is enrolled prior to 11release, through the exchange and effective upon the date of his or her release, in 12Medical Assistance, a qualified health plan, or some other form of minimum 13essential coverage on the date of his or her release from incarceration.

AB445,29,1914
(u) For those persons whose alcohol or other drug abuse or mental health 15treatment is not covered by a federally administered program, coordinate the 16relationships among the Medical Assistance program, the exchange, and the county 17departments under s. 51.42 or 51.437 to provide outpatient and inpatient mental 18health and alcohol or other drug abuse treatment with all of the following goals for 19the coordination:

AB445,29,2120
1. Maximizing coverage and improving access through the exchange for 21outpatient and inpatient treatment of mental illness and alcohol or other drug abuse.

AB445,29,2322
2. Improving the quality of treatment for persons with alcohol or other drug 23dependence or a mental illness.

AB445,30,514. Reducing the cost of the county departments under ss. 51.42 and 51.437 to 2taxpayers by avoiding unnecessary overlap between the improved coverage of 3alcohol or other drug abuse treatment or mental illness treatment by health plans 4offered through the exchange and the services provided by county departments 5under s. 51.42 or 51.437.

AB445,30,86
(v) Review the rate of premium growth within the exchange and outside the 7exchange, and consider the information in developing recommendations on whether 8to continue limiting qualified employer status to small employers.

AB445,30,119
(w) Credit the amount of any free choice voucher to the monthly premium of 10the plan in which a qualified employee is enrolled, in accordance with section 10108 11of the federal act, and collect the amount credited from the offering employer.

AB445,30,1312
(x) Consult with stakeholders relevant to carrying out the activities required 13under this chapter, including any of the following:

AB445,30,2020
(y) Meet all of the following financial integrity requirements:

AB445,30,2321
1. Keep an accurate accounting of all activities, receipts, and expenditures and 22annually submit to the secretary, the governor, the commissioner, and the legislature 23a report concerning such accountings.

AB445,31,224
2. Fully cooperate with any investigation conducted by the secretary under the 25secretary's authority under the federal act and allow the secretary, in coordination 1with the inspector general of the federal department of health and human services, 2to do all of the following:

AB445,31,65
c. Require periodic reports in relation to the activities undertaken by the 6authority.

AB445,31,137
3. In carrying out its activities under this chapter, not use any funds intended 8for the administrative and operational expenses of the authority for staff retreats, 9promotional giveaways, excessive executive compensation, or promotion of federal 10or state legislative or regulatory modifications, except that this subdivision does not 11prohibit the authority from advocating, as part of administering the exchange, for 12policies that the authority determines are in the best interest of the exchange or of 13individuals and employees receiving coverage through the exchange.

AB445,31,1514(2) The authority may do all of the following relating to the exchange under s. 15636.25 (1):

AB445,31,1716
(a) Contract with a 3rd-party administrator for the provision of services on 17behalf of the exchange.

AB445,31,1919
(c) Enter into agreements with or establish sub-exchanges.

AB445,31,2120
(d) Create any other exchange, or component of the exchange, that is provided 21for under federal law.

AB445,31,2522(3) The authority shall seek grants to the fullest extent to which it is eligible, 23including amounts under section 1311 (a) (1) and (4) of the federal act, or other 24funding from the federal or state government for which it may be eligible and from 25private foundations for the purpose of the exchange under s. 636.25 (1).

AB445,32,21636.42Health benefit plan certification.(1) The authority may certify a 2health benefit plan as a qualified health plan if all of the following are true:

AB445,32,63
(a) The plan provides the essential health benefits package described in section 41302 (a) of the federal act, except that the plan is not required to provide essential 5benefits that duplicate the minimum benefits of qualified dental plans, as provided 6in sub. (5), if all of the following are satisfied:

AB445,32,87
1. The authority has determined that at least one qualified dental plan is 8available to supplement the plan's coverage.

AB445,32,139
2. The health carrier makes prominent disclosure at the time it offers the plan, 10in a form approved by the authority, that the plan does not provide the full range of 11essential pediatric benefits and that qualified dental plans providing those benefits 12and other dental benefits not covered by the plan are offered through the exchange 13under s. 636.25 (1).

AB445,32,1514
(b) The premium rates and contract language have been filed with and not 15disapproved by the commissioner.

AB445,32,1916
(c) The plan provides at least a bronze level of coverage, as determined under 17s. 636.30 (1) (e), unless the plan is certified as a qualified catastrophic plan, meets 18the requirements of the federal act for catastrophic plans, and will only be offered to 19individuals eligible for catastrophic coverage.

AB445,32,2320
(d) The plan's cost-sharing requirements do not exceed the limits established 21under section 1302 (c) (1) of the federal act and, if the plan is offered through the 22SHOP Exchange, the plan's deductible does not exceed the limits established under 23section 1302 (c) (2) of the federal act.

AB445,32,2424
(e) The health carrier offering the plan satisfies all of the following:

AB445,33,211. Is licensed and in good standing to offer health insurance coverage in this 2state.

AB445,33,63
2. Offers at least one qualified health plan in the silver level and at least one 4qualified health plan in the gold level through each component of the exchange in 5which the health carrier participates. In this subdivision, “component" refers to the 6SHOP Exchange or the exchange under s. 636.25 for individual coverage.

AB445,33,97
3. Charges the same premium rate for each qualified health plan without 8regard to whether the plan is offered directly from the health carrier or through an 9insurance intermediary.

AB445,33,1110
4. Does not charge any cancellation fees or penalties in violation of s. 636.25 11(3).

AB445,33,1312
5. Complies with the regulations developed by the secretary under section 1311 13(d) of the federal act and such other requirements as the authority may establish.

AB445,33,1914
(f) The plan meets the requirements of certification as required by any rules 15promulgated under s. 636.46 (1) and by the secretary under section 1311 (c) of the 16federal act, including minimum standards in the areas of marketing practices, 17network adequacy, essential community providers in underserved areas, 18accreditation, quality improvement, uniform enrollment forms, and descriptions of 19coverage and information on quality measures for health benefit plan performance.

AB445,33,2220
(g) The authority determines that making the plan available through the 21exchange under s. 636.25 (1) is in the interest of qualified individuals and qualified 22employers in this state.

AB445,33,2423(2) The authority shall not exclude a health benefit plan for any of the following 24reasons or in any of the following ways:

AB445,33,2525
(a) On the basis that the plan is a fee-for-service plan.

AB445,34,11(b) Through the imposition of premium price controls by the authority.

AB445,34,42
(c) On the basis that the plan provides treatments necessary to prevent 3patients' deaths in circumstances the authority determines are inappropriate or too 4costly.

AB445,34,65(3) The authority shall require each health carrier seeking certification of a 6health benefit plan as a qualified health plan to do all of the following:

AB445,34,127
(a) Submit a justification for any premium increase before implementation of 8that increase. The health carrier shall prominently post the information on its 9Internet site. The authority shall take this information, along with the information 10and the recommendations provided to the authority by the commissioner under 42 11USC 300gg-94 (b), into consideration when determining whether to allow the health 12carrier to make the plan available through the exchange under s. 636.25 (1).

AB445,34,1513
(b) 1. Make available to the public, in the format described in subd. 2., and 14submit to the authority, the secretary, and the commissioner, accurate and timely 15disclosure of all of the following: